Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Intermetatarsal bursitis — inflammation of the small bursa located between the metatarsal heads in each intermetatarsal web space — produces plantar forefoot pain nearly identical in distribution and quality to Morton’s neuroma, yet requires different treatment. Distinguishing bursitis from neuroma is clinically important because cortisone injection is appropriate first-line treatment for bursitis but should be used with caution in neuroma (risk of perineural fibrosis), and alcohol sclerosing injection is specific to neuroma.

Distinguishing Features

Location and character: both intermetatarsal bursitis and Morton’s neuroma produce pain at the web space between the metatarsal heads — most commonly the third (between third and fourth metatarsal heads). The pain of bursitis tends to be a broader, more diffuse aching, while neuronal pain is often more electric or burning with radiation into the toes. Mulder’s click: a positive Mulder’s click (palpable ‘click’ produced by laterally compressing the metatarsals while pressing on the web space from below) is more specific for neuroma than bursitis — though it can be positive in either condition with significant bursitis. Ultrasound: the critical diagnostic tool — bursitis appears as an anechoic (dark) fluid-filled sac between the metatarsal heads, while a Morton’s neuroma appears as a hypoechoic (darker than surrounding tissue) solid ovoid mass. The two conditions frequently coexist — a neuroma creates local inflammation that secondarily causes bursitis, and both can be seen on ultrasound simultaneously. Response to treatment: bursitis responds rapidly and completely to a single ultrasound-guided corticosteroid injection; neuroma is slower to respond and may require multiple treatment sessions.

Treatment

Isolated bursitis: ultrasound-guided corticosteroid injection (triamcinolone 20–40mg into the bursa) produces complete resolution in 70–80% of cases. Metatarsal pad/orthotic: off-loading the metatarsal heads with a metatarsal pad distributes pressure away from the inflamed bursa. Footwear modification: wider toe box and lower heel to reduce metatarsal head loading. Neuroma with secondary bursitis: treat both — the neuroma-specific treatment (alcohol sclerosing injection series, NSAID course) combined with bursal injection. Dr. Biernacki at Balance Foot & Ankle performs diagnostic ultrasound to differentiate intermetatarsal bursitis from Morton’s neuroma and provides targeted ultrasound-guided treatment. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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Frequently Asked Questions

What does Morton’s neuroma feel like?

Morton’s neuroma typically causes a burning, stinging, or electric-shock sensation in the ball of the foot, often radiating to the 3rd and 4th toes. Many patients describe the sensation of stepping on a pebble or having a bunched-up sock underfoot.

Can Morton’s neuroma go away on its own?

Very early-stage neuromas may improve with footwear changes alone. However, established neuromas typically require treatment — padding, orthotics, cortisone injections, or alcohol sclerosing injections. About 20–30% eventually need surgical excision.

What is the success rate of Morton’s neuroma surgery?

Neuroma excision has a 75–85% success rate for long-term pain relief. The risk of permanent numbness in the affected toes should be discussed before surgery. Minimally invasive approaches have similar outcomes with faster recovery.

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Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

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Intermetatarsal Bursitis Treatment in Michigan

Ball-of-foot pain isn’t always Morton’s neuroma — intermetatarsal bursitis causes similar symptoms but requires different treatment. Our podiatrists use ultrasound-guided evaluation to accurately diagnose the source of your forefoot pain and provide targeted treatment.

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Clinical References

1. Betts RP, Stockley I, Getty CJ, et al. Foot pressure studies in the assessment of forefoot arthroplasty. Foot Ankle. 1988;8(5):279-285.
2. Sharp RJ, Wade CM, Hennessy MS, Saxby TS. The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesion on symptoms. J Bone Joint Surg Br. 2003;85(7):999-1005.
3. Owens R, Gougoulias N, Guthrie H, Sakellariou A. Morton’s neuroma: clinical testing, imaging, pathophysiology, diagnosis, and management — a narrative review of the evidence. Ann Med. 2011;43(4):303-315.

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.